Ageing as a cross-cutting theme - PowerPoint Presentation

Slide1

Ageing as a cross-cutting theme

Dr Miles D WithamClinical Reader in Ageing and HealthSlide2

Ageing – why bother?

Core business of the NHSGrowth area…Current healthcare systems not equipped to deal with ageing populations and their attendant issues

Underdeveloped evidence base

Lot of ill-conceived ‘innovation’

Very little evaluationSlide3

Healthy ageing – why bother?

Dramatic increases in longevity over last centuryDebatable as to whether this is accompanied by increase in healthy life expectancy

So plenty of work still to do here!

‘adding life to years’ – common, but still useful adageSlide4

Christensen K et al. Lancet

.

2009; 374:

1196–1208Slide5

Crimmins EL et al. J

Gerontol B Psychol Sci Soc Sci.

2011;

66B(1): 75–86. Slide6

Why focus on ageing as a College?

ImpactNatural home for collaborative workingSome strengths in this area already

Historically under-resourced area of endeavour (but this is changing)Slide7

FuturAGE roadmap

FuturAGE report 2011Slide8

So what’s wrong with ageing research at the moment?

Basic science in ageing is divorced from clinical practiceSocial science (gerontology) is also divorced from clinical practice

Clinical practice lacks an evidence base relevant to older people

Clinical research is often small-scale, single centre, lacking critical mass and lacking the right multidisciplinary ingredients

Lack of ‘follow through’ from discovery, intervention development, testing to implementation and disseminationSlide9

The evidence mismatch

Most clinical studies look at young people with single diseasesOlder people typically have multiple diseases, and are taking multiple drugsThey lack homeostatic reserve, are highly prone to decompensation, and have multiple functional impairments (the state of

frailty

)

Older people are highly heterogeneousSlide10

So evidence accumulated in younger people may not apply to older people

This leads either to: - Inappropriate use of interventions in older people that may be either useless or harmful

- Ignoring potentially efficacious interventions in older people because practitioners don’t think the evidence applies to

their

patientSlide11

Health care systems

All this is delivered in healthcare systems set up for:Single diseasesEpisodic care

And increasingly…Mobile, articulate, IT-savvy people

Which is not very useful for older people!Slide12

So how do we change this?

We need more of:Interventions that target underlying pathological processes common to multiple disorders

Studies that deliver evidence that is relevant to older, frail people with

multimorbidity

Healthcare delivery systems designed for (and by!) older people, which are flexible enough to deal with the heterogeneity of ageSlide13

We need less of:

Single organ studiesHighly selected populations

And also less of:

Small pieces of disjointed work

Small, isolated teamsSlide14

Where could we target?

Multiple points in the lifecourse:In utero

Childhood

Young adulthood

Healthy ageing

Ameliorating disease and decline

End of life care

Danger of an embarrassment of riches…Slide15

What would an effective research strategy look like?

Multidisciplinary – just like good clinical careInvolve older people in priority setting and designSpectrum of methodological expertise:

Qualitative

Systematic reviews

Basic science

Epidemiology

Complex intervention development

Trials

Implementation science

Focus – no point starting a line of enquiry unless you are going to take it through to definitive trials and implementationSlide16

The UK picture

Historically, lack of join up between basic science, gerontology and clinical geriatric medicineLack of capacity in clinical geriatric medicineMultidisciplinary work is common

Lot of observational work

Few small trials

Very few large trialsSlide17

Lack of critical mass until recently

Some good work, but lacking multicentre / UK-wide approachDundee: small trials

Edinburgh: delirium and dementia

Bradford,

Notts

: Health services research

Southampton, Cambridge: Epidemiology

Newcastle: Basic science, epidemiologySlide18

Local expertise

Ageing and HealthOxidative stress (CVDM)Trials (TCTU)Epidemiology (DEBU)

Qualitative expertise (SNM)

Some systematic review expertise (scattered)

Implementation science (SISCC) – early stagesSlide19

Examples from A+H

Health and Social care data integration:Team from A+H, Clin Pharm, DEBU, HIC, SCPHRP

Now ESRC / Scottish

Govt

funded PhD (

cosupervised

by A+H / SNM / PHS / Napier)

Adherence in older HF patients

:

Team from A+H, SNM, Health psychology (from Galway)

CSO-funded PhDSlide20

Physical activity in older people

Team from A+H, DEBU (PACS cohort); newer collaborations with SNM (PhD on care home physical activity); Computing and Design (BeSIDE

project)

Pharmaceutical interventions to improve physical function in older people

Teams from A+H,

Clin

Pharm, Imaging, IMAR, Health economics (Aberdeen), trials (TCTU and HSRU Aberdeen)

Multicentre trials (

BiCARB

, LACE);

S

ingle centre trials (PREFACE, SPIROA, ALFIE)Slide21

Pitfalls of cross-cutting themes

Getting Ageing and Health to do all the work

Tacking the word ‘Ageing’ onto work in a superficial way

Chasing grant calls with the word Ageing in them, rather than pursuing a coherent programme of work

Keeping the same structures and expecting cross-cutting work to magically happenSlide22

Conclusion

Ageing is a natural home for interdisciplinary, cross-cutting researchThere is a lot of work that needs to be doneThe funding and structures nationally are improving

UoD

has several inherent strengths in this area

A joined-up, focussed approach may be the best way to develop critical mass in selected areas

Local examples of collaboration give a good basis for future growth